Have you ever filed for bankruptcy? ____________Been evicted from tenancy?______________________ Late on your rent payments? __________________Refused to pay rent when it was due? ______________ Been convicted of a felony?____________Who referred you to Grant Rentals?______________________

Who to contact in case of emergency:____________________________ Phone: (_____) ______________

Relationship _________________Address __________________________________________________ I hereby authorize Owner to conduct any credit and background checks on me that the Owner deems appropriate.

The applicant referenced above has applied for an apartment and has indicated you as their Landlord/ Employer. Please complete the following information and return it to us at your earliest convenience.

1. Lease dates ________________________________ 2. Rent amount $________________ Security Deposit amount $___________________ 3. Number of late payments:__________________________________________________ 4. Number of NSF checks in last 12 months_____________________________________ 5. Have any unauthorized persons lived in this unit?_______________________________6. Has this resident been found with a pet? _________________ Is it permitted? ________ 7. Have there been any noise problems? _________________________________________8. Have the police been called regarding the applicant or guests? ____________________, If yes please explain _____________________________________________________ 9. Has the applicant or guests acted in a physically violent or verbally abusive manner toward neighbors or staff? If yes, please explain _______________________________________ 10. Amount of security deposit refunded to tenant $______________ Please explain _______ ________________________________________________________________________ 11. 11. Would you rent to this resident again?_______________ 12. 12. Other problems?________________________________________________________13. 13. Are you related to this applicant? ________ If yes, how? _______________________

1. Starting date_______________________ 2. Salary_________________________ 3. Seasonal Part time Full time (please circle)- If part-time, how many hours/week?__________ 4. Continued Employment expected? Yes No 5. Are you related to this applicant? ________ If yes, how? ______________________